摘要
目的通过3例移植后淋巴增殖性疾病(post-transplant lymphoproliferative disorders,PTLD)患者的诊疗过程,探讨肾移植术后PTLD的病因、临床表现及诊疗措施。方法对首都医科大学附属北京朝阳医院从2010—2022年诊治过的确诊PTLD患者3例进行回顾性分析。结果肾移植患者术后均采用三联免疫抑制方案,移植后至确诊PTLD时间分别为5、6、120个月。三例患者均出现局部淋巴结增大引起的相应位置压迫症状,确诊后给予减少免疫抑制剂用量,辅以利妥昔单抗靶向治疗或化疗,1例患者完全缓解,2例患者病灶明显减小。结论PTLD是肾移植术后的少见并发症之一,预后较差,临床表现具有异质性,淋巴结肿大是本病的典型表现之一,早期完善影像学及组织病理学检查明确诊断,及早调整免疫抑制剂量同时应用利妥昔单抗结合化疗等措施可改善患者预后,降低患者病死率。
Objective Through the diagnosis and treatment process of 3 patients with post-transplant lymphoproliferative disorders(PTLD),the etiology,clinical manifestations and diagnosis and treatment measures of PTLD after kidney transplantation were discussed.Methods A retrospective analysis of 3 patients with PTLD diagnosed and treated in Beijing Chaoyang Hospital affiliated to Capital Medical University from 2010 to 2022 was performed.Results All patients had received three-drug-immunosuppression after transplantation,and the duration between renal transplantation and diagnosis of PTLD was 5 months,6 months,and 120 months,respectively.All patients had symptoms of compression at the corresponding location caused by enlarged regional lymph nodes.Upon diagnosis,the dosage of immunosuppressive drugs was reduced,supplemented with rituximab or chemotherapy.Clinical complete remission was achieved in one case,and the lesion of the remaining patients was significantly reduced.Conclusion PTLD is one of the rare complications after kidney transplantation,with poor prognosis and heterogeneous clinical manifestations.Lymph node enlargement is one of the typical manifestations of this disease.Early imaging and histopathological examinations are ideal for a definite diagnosis and early adjustment.The combination of immunosuppressive dose adjustment,application of rituximab and chemotherapy as well as other measures can improve the prognosis and reduce the mortality of patients.
作者
郝长臻
高子豪
孙泽家
王玮
Hao Changzhen;Gao Zihao;Sun Zejia;Wang Wei(Department of Urology,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)
出处
《实用器官移植电子杂志》
2022年第4期332-336,共5页
Practical Journal of Organ Transplantation(Electronic Version)
基金
2017年市科委“首都临床特色应用研究”专项课题(Z171100001017055)。
关键词
肾移植
移植后淋巴增殖性疾病
病因
治疗
Renal transplantation
Post-transplant lymphoproliferative disorders
Pathogenesis
Treatment
